Machupo virus, the cause of BHF was considered an example of the Pavlovskii rules of natural nidality¹ until the host species, wild murid rodents (Calomys callosus), was shown to be monophyletic and of independent evolutionary history in northeastern Bolivia and not to occur throughout the species range.² BHF is characterized by outbreaks with fatality rates ~15%,³ some evidence of intra-familial transmission⁴ and no evidence of asymptomatic disease. Rodent abatement is effective in controlling outbreaks.⁵ The last reports of BHF were in 1994.⁶

Culture, serology and PCR (cf. #7 for review) are available from the CDC whose assistance should be sought promptly and prior to any attempts to ship specimens. Recommendations are available about risk of transmission, isolation procedures, pre- and post-exposure prophylaxis and therapy.⁸ (cf. also #9). In patients suspected of having VHF, the differential diagnosis includes fulminant hepatitis, leptospirosis, malaria and meningococcal meningitis. Treatment of BHF with intravenous ribavirin is reported.¹⁰ South American hemorrhagic fevers were reviewed.^11-13